The mechanism of action of metronidazole is in biochemical restoration of 5-nitro group of metronidazole by intracellular transport proteins of anaerobic microorganisms and protozoa. The recovered 5-nitro group of metronidazole interacts with nandrolone phenylpropionate profile microbial cells by inhibiting synthesis of nucleic acids, which leads to the death of the bacteria.

Pharmacokinetics
When administered intravenously, 500 mg of metronidazole over 20 minutes anaerobic infection in patients with serum drug concentration one hour was 35.2 g / ml after 4 hours – 33.9 ug / ml 8 through watches – 25.7 ug / ml. The drug has a high penetrating power, achieving bactericidal concentrations in most tissues and body fluids, including the lungs, kidneys, liver, skin, spinal fluid, brain, bile, saliva, amniotic fluid, oral abscesses, vaginal secretions, semen, breast milk . Binding to blood proteins weak and does not exceed 10-20%. In normal bile concentration of metronidazole in bile after intravenous administration can significantly exceed the concentration in the blood plasma metronidazole.
Excretion metronidazole carried kidney nandrolone phenylpropionate profile(20% of drug is excreted in unaltered form). The half-life of metronidazole is 6-7 hours. Renal clearance of 10.2 ml / min. In patients with impaired renal function after repeated administration of the drug may be a cumulation of metronidazole in blood serum. Therefore, in patients with severe renal insufficiency receiving frequency of metronidazole should be reduced.

Indications

Metronidazole, solution for infusion is indicated for the treatment of infections caused by susceptible to malaria infections:

prevention and treatment of anaerobic infections in surgical interventions, mainly in the abdominal organs and urinary tract;

Hypersensitivity to nandrolone phenylpropionate profile metronidazole or other nitroimidazole derivatives;

organic lesions of the central nervous system (including epilepsy);

leukopenia (including history);

hepatic insufficiency (in the case of the appointment of high doses);

I trimester of pregnancy;

lactation.

Carefully

pregnancy trimesters II and III (only for health reasons);

renal and / or hepatic impairment.

Use during pregnancy and lactation

Metronidazole crosses the placenta and should not be prescribed the drug in the first trimester of pregnancy, in the future should only be used if the potential benefits of the drug for the mother than the potential risk to the fetus.
Because Metronidazole passes into breast milk, reaching its concentration close concentration in the blood plasma, it is recommended to stop breast-feeding during treatment with the drug.

Dosing and Administration

. Intravenous
Intravenous metronidazole is indicated for severe infections, as well as the absence of the possibility of taking the drug inside.
Single dose of 500 mg, the rate nandrolone phenylpropionate profile of intravenous continuous (jet) or drip over 12 years for adults and children – 5 ml per minute. The interval between injections – 8 hours. Duration of treatment is determined individually. The maximum daily dose – not more than 4 g According to testimony, depending on the nature of the infection, make the transition to maintenance therapy with oral metronidazole forms.
Children under 12 years of metronidazole administered 7.5 mg / kg of body weight in 3 divided doses at a rate of 5 ml . per minute
for the prevention of anaerobic infections before elective surgery on the pelvic organs and the urinary tract in adults and children over 12 years of metronidazole administered in the form of infusion at a dose of 500-1000 mg, in the day of surgery and the next day – 1500 mg / day ( 500 mg every 8 hours). After 1-2 days usually move on to maintenance therapy with oral metronidazole forms. Children under 12 years recommended the introduction of metronidazole intravenously in the same manner at a dose of 7.5 mg / kg body weight. The maximum daily dose in children aged up to 12 years -. 22.5 mg / kg body weight
For patients with severe renal impairment (creatinine clearance less than 30 ml / min) and / or liver daily dose of metronidazole is 1000 mg, the multiplicity of the introduction of 2 times.

Metronidazole, the solution for infusion is not recommended to mix with other drugs!

Food does not affect the absorption of the drug. The half-life is 8-10 hours, contact with blood proteins insignificant and does not exceed 10-20%. The drug rapidly enters the tissue (lung, kidney, liver, skin), bile, spinal fluid, saliva, semen, vaginal secretions, breast milk and pass the placental barrier. Metronidazole is metabolized in the liver by the oxidation and coupling with glucuronic acid. Withdrawal is carried out by 40-70% through the kidneys (in unmodified form – about 20% of the dose) and faeces. Patients with liver failure half-life remains unchanged.

Dosing and Administration In amoebiasis nandrolone phenylpropionate dosageadministered orally for 7 days, 1.5 g per day in 3 divided doses (adults) and 0.03-0.04 g / kg per day in 3 divided doses (children). When giardiasis drug prescribed for 5 days – the adult on 0.75-1.0 g per day, children 2-5 years at 0.25 g per day, children 5-10 years – 0,375 g per day and children 10-15 years – 0.5 g per day. Taken after meals 2-3 times a day. If trichomoniasis in females (urethritis, and vaginitis) administered once at a dose of 2 g or a course of treatment for 10 days: 1 tablet (0.25 g), 2 times per day . In parallel with oral prescribed evening for 1 vaginal suppository or vaginal tablet containing trenbolone side effects. To exclude a possible reinfection it is necessary to treat both sexual partners. The course of treatment is repeated if necessary after 4-6 weeks. If trichomoniasis in men ( urethritis) administered once at a dose of 2 g or a course of treatment for 10 days on 1 tablet (0.25 g), 2 times a day. When nonspecific vaginitis used 0.5 g 2 times a day for 7 days. In the treatment of anaerobic infections adults appoint Trihobrol 1-1.5 grams per day, children – at the rate of 0.02-0.03 g / kg per day.

Interaction with other drugs Pharmacodynamic : joint use of oral with antibiotics-aminoglycosides (neomycin, streptomycin, gentamicin, etc.), Erythromycin inhibits pathogenic flora in the digestive tract, reducing the probability of complications after surgery on the colon and rectum. Influenced may increase the effects of indirect anticoagulants. Under the influence of barbiturates may reduce , since its inactivation in the liver is accelerated. The spectrum of action expands when combined his appointment with sulfonamides and cephalosporins. In a joint application and ethyl alcohol as a result of blockade side effects of letrozole. enzyme aldehyde dehydrogenase possible facial flushing, vomiting, abdominal pain, etc. should not be combined nandrolone phenylpropionate dosagewith Teturamom as the interaction of these drugs is possible depression of consciousness, psychotic disorders. Pharmacokinetic : adsorbents, cholestyramine, binding and enveloping means reduce the absorption in the gastrointestinal tract.

Side effects: In rare cases, there is nausea, a metallic taste in the mouth, anorexia, epigastric pain, vomiting, diarrhea, headache, dizziness, as well as local skin reactions such as hives and itching. Very rarely -. Convulsions, confusion, hallucinations, depression Prolonged treatment with high doses may occur leukopenia, peripheral neuropathy. We describe an extremely rare and reversible cases of pancreatitis. Perhaps staining of urine reddish-brown color due to the presence of pigments associated with metabolism nandrolone phenylpropionate dosage.

Treatment – symptomatic: for arrhythmia – intravenous , in heart failure – cardiac glycosides, with marked decrease in blood pressure – in / in a liquid or vasopressor agents such as norepinephrine, phenylephrine (to avoid purpose of alpha- and beta-agonists such as epinephrine as possible paradoxical decrease in blood pressure by blocking the alpha-adrenoceptor trifluoperazine), in convulsions – diazepam (barbiturates avoided due to possible subsequent npp deca depression and respiratory), parkinsonism – difeniltropin diphenhydramine. Control functions of the cardiovascular system during at least 5 days, the central nervous system, respiration, body temperature measurement, psychiatric counseling. Dialysis is ineffective.

Interaction with other drugs
With simultaneous application triftazin with other drugs, have a depressing effect on the central nervous system (funds for general anesthesia, opioids, ethanol (alcohol) and containing its drugs, barbiturates, tranquilizers, and others.) May increase CNS depression as well as respiratory depression;

tricyclic antidepressants, maprotiline, or monoamine oxidase inhibitors – increase the risk of neuroleptic malignant syndrome; with anticonvulsants – perhaps lowering the seizure threshold; with preparations for the treatment of hyperthyroidism – increased risk of agranulocytosis; with other drugs causing extrapyramidal reactions – may increase the frequency and severity of extrapyramidal disorders;

with antihypertensive drugs – can be severe orthostatic hypotension; with ephedrine – may weaken the vasoconstrictor effect of ephedrine. When treating triftazin avoid administration of epinephrine (adrenaline), since distortion may effect epinephrine, which can lead to a drop in blood pressure. Antiparkinsonian effect of levodopa is reduced due to the blocking of dopamine receptors. Triftazin can suppress the effect of amphetamines, clonidine, guanethidine. Triftazin enhance the anticholinergic effects of other drugs, and the antipsychotic effect of neuroleptics may be reduced.

In an application with triftazin prochlorperazine may come a prolonged loss of consciousness.

Combination with lithium therapy increases the risk of extrapyramidal complications. Triftazin can mask some of the manifestations of ototoxicity (tinnitus, vertigo), ototoxic drugs providing an action. Other hepatotoxic drugs increase the risk of hepatotoxicity. Antacids containingnpp deca reduce the absorption triftazine.

Good absorbed from the gastrointestinal tract of the locations and parenteral administration. Time to maximum concentration after intramuscular administration of 1 to 2 hours. The connection to plasma proteins 95% (so weakly dialyzed). It is metabolized in the liver, elimination half-life of 15-30 hours, most metabolites are pharmacologically inactive. Excreted by the kidneys and the bile. Triftazin crosses the placenta.

Indications for use:

schizophrenia and other mental illnesses, nadrolone occurring with delusions, hallucinations and psychomotor agitation;

vomiting of central origin.

Contraindications:

increased individual sensitivity;

inhibition of the function of the central nervous system and comatose states from any cause;

brain injury;

liver disease, kidney and blood-forming organs in violation of the functions;

progressive system of the brain and spinal cord diseases;

peptic ulcer and 12 duodenal ulcer during the exacerbation;

heart failure in the stage of decompensation; severe hypotension; diseases accompanied by the risk of thromboembolic complications;

angle-closure glaucoma (risk of increased intraocular pressure);

prostatic hyperplasia;

myxedema;

pregnancy, breast-feeding;

Children up to age 3 years.

Precautions:
elderly, vomiting (antiemetic effect of phenothiazines may mask vomiting associated with an overdose of other drugs.).

Triftazin used after comparing the risks and benefits of treatment in patients with alcohol intoxication, Reye’s syndrome, cachexia, as well as breast cancer, Parkinson’s disease, gastric ulcer and duodenal ulcers, urinary retention, chronic respiratory diseases (especially in children), epileptic seizures.

Dosage and administration:

Triftazin Inside, after a meal.

Doses are selected individually according to the severity of the condition, for the dose titration should be used with the appropriate dosage forms (lower) dose. When nadrolone the maximum therapeutic effect dose was gradually reduced to maintenance. Usually, for the treatment of anxiety disorders adults appoint 1 mg 2 times a day. For patients with psychotic disorders begin to 2 mg 2-5 times a day. For optimal therapeutic effect dose gradually increased to 15-20 mg / day, divided by 2-3 hours, maximum daily dose – 40 mg.

To obtain the desired therapeutic effect and improvement of the patient must usually 2-3 weeks.

6-12 years old children, psychotic disorders, administered at 1 mg 1 -2 times a day, the dose may be increased to 4 mg / day as needed. The dose for children over 12 years – 5-6 mg per day, divided into several stages.

Adults with vomiting – 1-2mg 2 times a day. For elderly patients the initial dose should be reduced by 2 times.

Following oral administration, both the active drug component quickly absorbed in the gastrointestinal tract nandrolon.
The bioavailability after oral administration of amoxicillin is 80%, does not affect food intake on the drug absorption. The time to maximum concentration nandrolon is 1-2 hours half-life – 1 hour Plasma protein binding -. 20%. Amoxicillin is distributed in most tissues and body fluids, it crosses the placental barrier and is found in breast milk. Write mainly kidneys (glomerular filtration and tubular secretion) – 70-80%, and in the bile – 5-10%. Sulbactam pivoxil is hydrolyzed in the gastrointestinal tract to improve absorption of sulbactam. The time to maximum concentration nandrolon, as well as for amoxicillin is 1 -2 hours Linking proteins -. 40%. The half-life of 1 hour.
Sulbactam no effect on the pharmacokinetics of amoxicillin.

postoperative infections.
Prevention of infectious and inflammatory complications in surgery.Contraindications:
Hypersensitivity to the drug and other beta-lactam antibiotics, infectious mononucleosis (including when a morbilliform rash), ulcerative colitis (including those associated with taking antibiotics), up to 2 years (recommended for children under 2 years nandrolon oral use in the form of a suspension).Be wary.
Severe hepatic insufficiency, gastrointestinal disease (including a history of colitis associated with the use of penicillins), chronic renal failure . old age (due to the possible renal failure).

Pregnancy and lactation.
Use of the drug during pregnancy and lactation is possible only if the expected benefit to the mother outweighs the potential risk to the fetus. Nandrolon is excreted in breast milk, so breast-feeding should be discontinued, if necessary, the appointment during lactation.

Dosing and Administration
Inside, regardless of meals. Dosage regimen (dose given in terms of amoxicillin) set individually depending on the severity and localization of infection susceptibility. Adults and adolescents over 12 years appoint 250 mg 3 times a day. In severe infections, 500 mg 3 times daily or 1 g 2 times a day. A single dose is determined depending on the age:. For children aged 6-12 years – 250-500 mg, 2-6 years – 250 mg, the multiplicity of purposes – 3 times a day
Eating does not affect the absorption of the drug. Duration of treatment -up to 14 days.
In chronic renal insufficiency the dose is calculated according to the creatinine clearance. In this regard, for ease of selection of adequate doses recommended parenteral administration Trifamoksa IBL.